Final vote on one of the biggest pieces of legislation since devolution - the Human Transplantation (Wales) Bill - takes place tomorrow

A doctors’ leader has insisted that moves have been made to address concerns about proposed changes to the organ donation system in Wales.

Dr Tony Calland, chairman of BMA Wales’ medical ethics committee, said he felt the Health Minister Mark Drakeford had taken the appropriate steps to address the concerns about the role of the family in any donation decision.

His move to reassure came as the Royal College of Nursing (RCN) in Wales said that if the nation moved to a system presumed consent, it is vital the necessary training is put in place for nurses when they discuss the issue with their patients, or it could alter the relationship between the two.

Their comments come on the eve of the National Assembly’s final vote on one of the biggest pieces of legislation since devolution – the Human Transplantation (Wales) Bill – which could see Wales become the first in the UK to adopt the “opt out” system.

Under the Bill, people would have to put in place a clear indication of their wish not to donate their organs for them to be excluded from donation after death, otherwise their consent will be deemed to have been given.

Martin Semple, associate director of RCN Wales, said: “Most of our members feel that what is needed to increase organ donations is a change in culture generally, rather than a change in law. If you look at the numbers of organs being donated, they are increasing and this has been without any legislative change.

“The anxiety that our members have is that this [Bill] could change the nature of the relationship and the conversations between clinicians, nurses and patients. What’s required here is a consideration of the nurse and patient relationship, which can be developed at the point of this conversation.

“Often it’s the nurse that approaches patients and family members about these things and that conversation is so delicate. There is anxiety that the change in the law will be without the training. If the law is passed then we will support our members to develop the skills and resources needed.

“There is currently so much going on in the NHS at the moment with limited resources. If a change in the law happens, it’s very important that the infrastructure and training goes along with it.

“People need to have access to information and education at an early stage, for example when people go to their GP practice. The problem is GPs are already under significant amount of pressure. This must not be about first asking the questions at the time when the family’s loved one is in intensive care.”

If the Bill is passed tomorrow, the changes will take place in 2015, with a £2.8m two-year publicity campaign.

Concerns have previously been raised about the new system’s impact, with those in opposition to an opt-out system suggesting it could put people off becoming donors.

There has also been confusion about the family’s role if the deceased person’s wishes were not clear.

Earlier this year, the National Assembly’s health and social care committee agreed to the general principles of the Bill but called for clarity about the role family and friends under the presumed consent system. The British Medical Association (BMA) also backed calls for further clarification on the issue.

In 2011-12, 37 people in Wales died while waiting for an organ transplant and the Welsh Government believes a change to presumed consent would increase the number of donors and help to save lives.

In April, the new Health Minister Prof Drakeford tabled amendments to the Bill to address concerns about the role of the family, saying they would have a “clear right of objection”.

He said: “Deemed consent will bring about a cultural shift in the way donation proceeds in Wales. It will alter the nature of some of the most difficult conversations any family might face.

“Deemed consent donation will not go ahead in the absence of any family member. I will bring forward an amendment, which will provide a clear right of objection for family members, where they can confirm that a potential donor would not have wished donation to take place.

“The result, I believe, is that we will have a better Bill, a Bill which will do what everyone wishes to see – fewer lives lost, in circumstances where donation makes that difference.”

Religious organisations have, however, argue that the amendments still fail to take into account the feelings of bereaved family members.

A joint statement by faith leaders, including Archbishop of Wales Dr Barry Morgan, the Catholic Archbishop of Cardiff, George Stack, and Saleem Kidwai, of the Muslim Council of Wales, has called on AMs to amend the Bill during tomorrow’s vote.

It said: “Concern about protecting the role of the family has been voiced throughout the development of this legislation. This dissatisfaction was acknowledged by the Minister, who said that he would bring forward amendments to address concerns. Far from making the Bill better and less controversial, however, they actually make it more controversial.

“They make it crystal clear that unless the family can provide information about the donation decision of the deceased, they can have no influence regarding the deeming of consent.

“The law must be amended if it is not to be inhuman, unfeeling before the suffering of relatives, and a danger to the public trust and support which are necessary for the practice of organ donation to flourish. Without this there is a real danger that the law could backfire.”

But Dr Calland said he felt Prof Drakeford had taken the appropriate steps to address the concerns.

He said: “I think the Bill is not exactly as how we would have written it and there are a small number of concerns around the role of the family but I think the Minister has addressed most of those and I think he worked very hard to make sure it was satisfactory. We are supportive of the Bill.

“In terms of NHS capacity – it’s hard to deal with anything new, but I do not think that is a particular concern. People will work hard to make sure it works.”

And it is understood further amendments will be tabled before tomorrow’s vote.

Addressing the RCN’s concerns, a Welsh Government spokesman said: “By making the known views of the potential donor clearer we believe that this will lead to better informed discussions between families and clinicians in which trust will be strengthened rather than diminished.”

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